Ontario eReferral – eConsult – HL7® FHIR® Implementation Guide

Scope

The Ontario eReferral – eConsult FHIR Implementation Guide covers the referral patterns for various pathways such as an EMR integration with a Home to Community Care Solution, Primary Care to Home and Community Care, Acute Care, etc.  The Implementation Guide also incorporates the eConsult pathway where cases can be submitted to a managed specialty, directly to a specialist, or to a managed group. 

This implementation guide describes the business considerations and implementation details for enabling interoperability between two referral systems to initiate and manage an electronic referral as well as an electronic consult.

The Implementation Guide also provides a detailed use case to support the contribution of referral information to the Provincial eReferral Repository. The eReferral Repository is a recipient system that relies on other systems (typically a referral management system) to contribute referral data (such as in the case of Central Waitlist Management system) that take place over the lifecycle of the referral.

The following patterns have been provided in this release of the implementation guide to facilitate referral and consult workflows:

• SMART on FHIR messaging pattern where a Referral Management System (RMS) is directly launched in a clinician’s Point of Service (POS) system and enables users to complete the initial eReferral request, including the initial appointment date and time.
• Direct messaging where two RMSs exchange referral messages (e.g., initial eReferral request, appointment updates, communications and notifications) via FHIR-based API interfaces.
• RESTFul FHIR API for systems wishing to conform to the RESTful FHIR API requirements. The focus is on the expected use of FHIR's RESTful API to support the exchange of information with a Referral Management System (RMS).

Status

This implementation guide is for trial use and has gone through a formal governance committee review and approval process resulting in a balloted draft status at this time.

To address the feedback received from Open Review, a new version of the eReferral – eConsult Implementation Guide v0.11.1 is available for public access.

Currently FHIR R4 is mixed normative and standards for trial use so additional changes by HL7 are expected. We will continue to monitor developments and assess any potential impacts and publish updates as they emerge.

*SIMPLIFIER.NET is a web-based FHIR registry built by Firely that serves as the hosting platform for the Canadian FHIR Registry sponsored by Canada Health Infoway